NPI 1487004636

Derek Port, ATC

Practitioner Athletic Trainer Campbellsville, KY

Practice location

Address: 1 University Dr Upo #823, Campbellsville, KY 42718-2190
Phone: (270) 789-5544
Fax: (270) 789-5199

Registered specialties

Athletic Trainer Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 2255A2300X Licence AT512 (KY)

Other Specialist/Technologist providers in Kentucky →

Registry record

NPI: 1487004636
Entity type: Individual
Sex (as registered): Male
NPI issued: 20 Jun 2016
Record last updated: 20 Jun 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.